1649340753 NPI number — DR. ARTHUR GUDEON DPM

Table of content: DR. ARTHUR GUDEON DPM (NPI 1649340753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649340753 NPI number — DR. ARTHUR GUDEON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUDEON
Provider First Name:
ARTHUR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649340753
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6406 FLEET STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REGO PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-896-3080
Provider Business Mailing Address Fax Number:
718-896-3060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6406 FLEET STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-896-3080
Provider Business Practice Location Address Fax Number:
718-896-3060
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N0020481 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4228829 . This is a "AETNA MC" identifier . This identifiers is of the category "OTHER".
  • Identifier: DP09044728 . This is a "WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0017601 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3C9512 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 49271 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1381 . This is a "BLUE CROSS BLUE SHEILD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 56514 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9577075 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P900597 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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